UHC Routine Testing Management Policies to Be Implemented in Three More States in April

UnitedHealthcare (UHC) is now implementing new Routine Testing Management Policies for laboratory services, tests, and procedures in North Carolina, Nebraska, and Rhode Island.

Effective April 1, 2026, UHC is applying automated postservice, prepayment policy enforcement to claims reporting laboratory services performed in office, in hospital outpatient settings, and at independent laboratory locations in these states. The purpose of the policies, according to UHC, is to provide guidelines on the circumstances and frequency of these tests being considered for reimbursement. The policies address:

• Flow cytometry
• Diabetes mellitus testing
• Diagnostic testing of iron homeostasis and metabolism
• Enzyme testing for acute pancreatitis
• Prostate biopsy specimen analysis
• Intestinal dysbiosis and fecal microbiota transplant testing
• Diagnostic testing for influenza
• Homocysteine testing for metabolism
• Lyme disease testing
• Bone turnover marker testing of osteoporosis
• Fecal calprotectin testing
• Biomarker testing for autoimmune rheumatic disease
• Diagnostic testing for inflammatory bowel disease
• Onychomycosis testing
• Immune cell function assay
• Biomarker testing for chronic heart failure
• Epithelial cell cytology
• Intracellular micronutrient analysis

The policy was previously effective for dates of service on or after Dec. 1, 2025, for all states except Arkansas, Colorado, Kentucky, Ohio, North Carolina, Nebraska, and Rhode Island. These policies do not apply to laboratory services, tests, and procedures provided in emergency rooms, hospital observation units, or hospital inpatient settings.

Source:

https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-reimbursement/rpub/UHC-COMM-RPUB-January-2026.pdf

https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-reimbursement/rpub/UHC-COMM-RPUB-September-2025.pdf